Rojas-Machado et al reported the DIACOLE index for the diagnosis of anastomotic leak following colorectal surgery for colorectal cancer. The authors are from University Hospital Alicante and Migual Hernandez University in Spain.
DIACOLE = diagnostic colorectal leakage
Patient selection: status post colorectal resection for cancer
Parameters:
(1) postoperative temperature in °C
(2) postoperative blood transfusion
(3) surgical wound infection
(4) duration of ileus (prolonged if lasting > 3 days)
(5) diarrhea
(6) abdominal pain
(7) cardiac complications
(8) respiratory tract complications
(9) neurological complications
(10) urinary complications
(11) white blood cell count per microliter
(12) blood urea nitrogen in mg/dL
(13) C-reactive protein concentration in mg/dL on third postoperative day
|
Parameter |
Finding |
Points |
|
postoperative temperature |
< 38°C |
0 |
|
|
>= 38°C (fever) |
1.517 |
|
postoperative blood transfusion |
no |
0 |
|
|
yes |
1.635 |
|
surgical wound infection |
no |
0 |
|
|
yes |
1.5 |
|
duration of ileus |
<= 3 days |
0 |
|
|
> 3 days (prolonged) |
1.497 |
|
diarrhea |
no |
0 |
|
|
yes |
1.366 |
|
abdominal pain |
no |
0 |
|
|
yes |
1.632 |
|
cardiac complications |
no |
0 |
|
|
yes |
1.879 |
|
respiratory tract complications |
no |
0 |
|
|
yes |
1.742 |
|
neurological complications |
no |
0 |
|
|
yes |
2.318 |
|
urinary complications |
no |
0 |
|
|
yes |
1.209 |
|
white blood cell count |
<= 12,000 per µL |
0 |
|
|
> 12,000 per µL |
1.788 |
|
blood urea nitrogen |
<= 48 mg/dL |
0 |
|
|
> 48 mg/dL |
2.206 |
|
CRP on third postop day |
<= 20 mg/dL |
0 |
|
|
> 20 mg/dL |
3.602 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 23.891
• A score > 5.436 is associated with anastomotic leak and a radiological test is advised.
• If the score is > 3.065 then closer monitoring of the patient is indicated.
Performance:
• The area under the ROC curve was 0.91.
Specialty: Gastroenterology
